Washington State Recycling Association
Membership Form
Contact Name
*
First Name
Last Name
Company Name
*
Company Webpage
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Company Logo (skip if individual membership)
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Large Organization Membership
Enter description
$
735.00
Mid Size Organization Membership
$
525.00
Small Organization Membership
$
315.00
Nonprofit Membership
$
185.00
Individual Membership
$
135.00
Senior & Student Membership (non voting)
$
55.00
Gold Precious Metal Partnership
$
5,250.00
Silver Precious Metal Partnership
$
3,150.00
Bronze Precious Metal Partnership
$
1,625.00
Platinum Precious Metal Partnership
$
6,825.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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